Healthcare Provider Details

I. General information

NPI: 1124060678
Provider Name (Legal Business Name): SOUTHEASTERN OVERREAD SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 W MARKET ST SUITE A
GREENSBORO NC
27403-1590
US

IV. Provider business mailing address

PO BOX 16566
CHAPEL HILL NC
27516-6566
US

V. Phone/Fax

Practice location:
  • Phone: 336-852-3488
  • Fax: 336-852-3442
Mailing address:
  • Phone: 919-967-6646
  • Fax: 919-967-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: DALLAS A SMITH JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 336-852-3488